艾司西酞普兰合并正念认知治疗对广泛性焦虑障碍患者自尊和应对方式的影响

目的:探讨艾司西酞普兰合并正念认知治疗(MBCT)对广泛性焦虑障碍(GAD)患者自尊和应对方式的影响。方法:采用随机数字法将72例GAD患者分为研究组和对照组各36例;两组均给予艾司西酞普兰治疗,同时给予研究组MBCT;于治疗前和治疗8周后应用汉密尔顿焦虑量表(HAMA)、自尊量表(SES)和简易应对方式问卷(SCSQ)进行评定。结果:治疗后研究组HAMA评分明显低于对照组,SES评分明显高于对照组, SCSQ积极应对评分明显高于对照组,消极应对评分低于明显对照组(P均0.01)。结论:艾司西酞普兰合并MBCT能有效改善GAD患者的焦虑症状、自尊水平和应对方式。     

认知行为干预护理对抑郁症患者影响的临床对照研究

目的探讨认知行为干预护理对抑郁症患者应对方式的影响。方法采用随机数字表法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的64例抑郁症患者分为研究组和对照组各32例。两组患者均接受抗抑郁药物治疗,研究组合并认知行为干预护理,对照组仅予常规精神科护理。所有患者在入组时、治疗6周后采用汉密尔顿抑郁量表24项(HAMD-24)、抑郁自评量表(SDS)、焦虑自评量表(SAS)及简易应对方式问卷(SCSQ)进行评估。结果干预6周后研究组的HAMD-24、SDS、SAS得分较对照组低(P0.01);研究者组SCSQ中消极应对方式评分较对照组低(P0.01),积极应对方式评分则高于对照组(P0.01)。结论认知行为干预护理可能有利于改善抑郁症患者焦虑抑郁情绪和提高其积极应对能力。     

度洛西汀合并认知治疗对更年期女性抑郁症患者的疗效比较

目的评价度洛西汀合并认知治疗对更年期女性抑郁症患者的疗效和安全性。方法采用数字随机法将符合ICD-10诊断标准的60例更年期抑郁症患者分为研究组和对照组,各30例。研究组给予度洛西汀合并认知治疗,对照组单用度洛西汀治疗,疗程8周。采用汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA)评定疗效,副反应量表(TESS)评定不良反应。结果两组治疗8周后HAMD、HAMA评分与治疗前比较差异均有统计学意义(P<0.01),研究组在1、2、4、8周末HAMD、HAMA评分与对照组比较差异有统计学意义(P<0.05或0.01),减分率均高于对照组(P<0.05)。结论度洛西汀合并认知治疗对更年期女性抑郁症患者疗效优于单用度洛西汀。     

艾司西酞普兰合并认知行为治疗在老年抑郁症治疗中的作用

目的:探讨艾司西酞普兰合并认知行为治疗在老年抑郁症治疗中的作用。方法:将72例老年抑郁症患者随机分为艾司西酞普兰合并认知行为治疗组(研究组,36例)和艾司西酞普兰组(对照组,36例),给予相应的治疗8周。分别于治疗前及治疗1、2、4、6、8周给予汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表病情严重程度量表(CGI-SI)评分;治疗8周以HAMD减分率评价疗效;随访6及12个月观察患者服药的依从性及复发率。结果:研究组和对照组分别有34例和32例完成8周疗程。治疗前两组HAMD、HAMA、CGI-SI评分差异无统计学意义;治疗后两组各时间点HAMD、HAMA、CGI-SI评分较治疗前明显下降(P均<0.01)。治疗1～4周末研究组HAMD、HAMA、CGI-SI评分明显低于对照组(P均<0.01);6～8周两组间各量表评分及疗效比较差异无统计学意义。治疗6及12个月时研究组服药依从率显著高于对照组(χ2=4.942、7.675;P均<0.01);12个月时复发率研究组显著低于对照组(χ2=9.021,P<0.01)。结论:艾司西酞普兰合并认知行为治疗能够更快地改善老年抑郁症患者症状,提高远期服药的依从性,降低复发率。     

威廉姆斯生活技能训练对医学生应对方式的影响

目的探讨威廉姆斯生活技能训练(Williams Life Skills Training,WLST)对医学生应对方式的影响。方法将82名自愿参加报名的医学生分成研究组(n=40)和对照组(n=42)。研究组接受为期8周的威廉姆斯生活技能训练,对照组不采取任何干预措施。研究组36人(男15人,女21人)、对照组37人(男15人,女22人)完成了研究。所有被试干预前、后自评完成生活事件量表(Life Event Scale,LES),特质应对方式问卷(Trait Coping Style Question-naire,TCSQ)。结果 1.研究组:干预后LES中社交及其他问题的刺激量(0.62±2.40)均较干预前(1.30±2.59)显著降低(P<0.05),TCSQ中积极应对评分(34.67±5.43)较干预前(33.28±5.89)显著升高(P<0.05),消极应对评分(27.33±6.10)较干预前(29.31±5.80)显著降低(P<0.01);2.对照组:各项评分前后比较差异均无统计学显著性(P>0.05)。结论 WLST能够有效地改善医学生的应对方式,提高应对压力或生活事件的能力。     

重复超低频经颅磁刺激对首发抑郁症患者的早期疗效及认知功能影响的初步分析

目的探讨度洛西汀联合逍遥丸治疗首发抑郁症的疗效及安全性。方法将120例首发抑郁症患者随机分为研究组60例,对照组60例,分别给予度洛西汀联合逍遥丸与单用度洛西汀治疗,治疗8周。在治疗前与治疗后的第2、4、8周分别采用汉密尔顿抑郁量表(HAMD17)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表(CGI)进行疗效评定;用治疗时出现的症状量表(TESS)评定不良反应。结果研究组和对照组有效率分别为85%和70%,两组比较差异有统计学意义(χ2=3.871,P<0.05);两组治疗后的第2、4、8周HAMD17和HAMA评分及CGI评分比较,差异均具有统计学意义(P<0.01),研究组在治疗4、8周末HAMD17和HAMA评分下降较对照组显著,两组间比较差异有统计学意义(P<0.05和P<0.01);不良反应方面,研究组发生厌食和失眠的不良反应明显少于对照组,两组间比较差异均有统计学意义(P<0.05)。结论度洛西汀联合逍遥丸治疗抑郁症的疗效比单用度洛西汀更显著,能提高临床有效率,且不良反应少,安全性高。     

抑郁症患者总体幸福感与社会支持和应对方式的相关性

目的调查抑郁症患者的幸福感,探讨其总体幸福感与社会支持和应对方式的相关性。方法于2019年2月-9月在安徽省精神卫生中心焦虑抑郁科门诊及住院患者中选择120例符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断标准的抑郁症患者作为抑郁症组,同时从社区人员及患者家属中选择122例作为对照组。采用总体幸福感量表(GWB)(中国版)、社会支持评定量表(SSRS)、简易应对方式问卷(SCSQ)进行评定,应用Pearson相关分析及多元线性回归分析比较抑郁症患者GWB、SSRS与SCSQ评分的相关性。结果抑郁症患者GWB评分低于对照组,差异有统计学意义[(62.43±13.48)分vs.(84.97±10.02)分,t=-14.780,P<0.01];抑郁症患者GWB评分与SCSQ总评分和积极应对方式评分均呈正相关(r=0.378、0.460,P均<0.01);抑郁症患者GWB评分与SSRS客观支持、主观支持、对支持的利用度评分及总评分均呈正相关(r=0.354~0.561,P<0.05或0.01);SSRS客观支持、主观支持、对支持的利用度评分及总评分与SCSQ总评分和积极应对方式评分均呈正相关(r=0.234~0.398,P<0.05或0.01)。结论抑郁症患者幸福感较低,且其幸福感水平与社会支持和积极应对方式相关。     

小剂量奥氮平联合氟西汀治疗难治性抑郁症随机对照研究

目的评价小剂量奥氮平联合氟西汀治疗难治性抑郁症的临床效果。方法将我院收治的难治性抑郁症患者64例随机分为研究组和对照组,每组32例,研究组患者给予奥氮平2.5～5.0mg/d睡前口服,氟西汀20～40mg/d,晨起早餐后顿服;对照组仅给予氟西汀20～40mg/d,晨起早餐后顿服,2组疗程均为8周。治疗前和治疗后1、2、4、8周应用汉密尔顿抑郁量表(HAMD)进行评分并评价疗效,应用副反应量表(TESS)及实验室检查评定治疗安全性。结果治疗后2组HAMD评分均明显下降,与治疗前相比差异有统计学意义(P<0.05),研究组1、2、4、8周HAMD评分明显低于对照组,差异有统计学意义(P<0.05)。研究组临床有效率75.0%,对照组有效率53.7%,研究组有效率明显高于对照组(P<0.05)。2组均无明显不良反应,差异无统计学意义(P>0.05)。结论小剂量奥氮平联合氟西汀治疗难治性抑郁症具有较好的临床疗效,不良反应较小,对于单药治疗效果欠佳的难治性抑郁症患者可考虑小剂量奥氮平联合氟西汀治疗。     

氟伏沙明合并逍遥丸治疗抑郁症的临床观察

目的探讨氟伏沙明合并逍遥丸治疗抑郁症的疗效及安全性。方法将126例抑郁症患者随机分为研究组63例,对照组63例,分别给予氟伏沙明合并逍遥丸与单用氟伏沙明治疗,疗程8周。在治疗前及治疗后的第2、4、8周分别采用汉密尔顿抑郁量表(HAMD17)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表(CGI)进行疗效评定;用不良反应量表(TESS)评定不良反应。结果研究组痊愈41例,有效13例,有效率85.7%;对照组痊愈37例,有效7例,有效率71.0%,两组间有效率差异有统计学意义(χ2=4.013,P<0.05);与治疗前比较,两组治疗后的第2、4、8周HAMD17、HAMA及CGI评分比较,差异均具有统计学意义(P<0.01),研究组在治疗后4、8周末HAMD17和HAMA评分下降较对照组显著,两组间比较,差异具有统计学意义(P<0.05和P<0.01)。两组不良反应比较,研究组发生厌食和失眠的不良反应明显少于对照组,两组间比较差异均有统计学意义(P<0.05);结论氟伏沙明合并逍遥丸治疗抑郁症的疗效优于单用氟伏沙明,能提高临床有效率,且不良反应少,安全性高。     

奥氮平对伴有焦虑的抑郁症的治疗作用

目的:观察西酞普兰合并小剂量奥氮平治疗伴有焦虑的抑郁症患者的临床疗效和安全性。方法:将68例伴有焦虑的抑郁症患者随机分为两组,研究组给予西酞普兰合并奥氮平治疗,对照组给予西酞普兰治疗,疗程均为8周。采用汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评定临床疗效,治疗中出现的症状量表(TESS)评定不良反应。结果:治疗8周末两组HAMD及HAMA评分均显著性下降(P均<0.01)。研究组起效较快,显效率高于对照组(P<0.05),两组不良反应均较轻微。结论:西酞普兰合并奥氮平对伴有焦虑的抑郁症起效快,疗效肯定,安全性高,依从性好。     

Dialectical behavior therapy for depressed older adults: a randomized pilot study.

OBJECTIVE: Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. METHODS: They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). RESULTS: Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. CONCLUSION: Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults.     

美沙酮合并心理干预对海洛因依赖者的影响

目的:评估心理干预对美沙酮维持治疗患者的应对方式、压力感受和自我效能状况的影响。方法:将美沙酮维持治疗门诊的海洛因依赖者分为研究组(n=71)和对照组(n=55)。研究组给予为期3个月的心理干预。两组在入组时,1个月后以及3个月后评定应对方式问卷(SCSQ)、压力感受量表(PSS)、自我效能量表(SES),并进行评分比较。结果:与入组时相比,研究组干预后1个月、3个月应对方式、压力感受、自我效能评分的差异均有统计学意义(P<0.01)。干预后1个月两组间积极应对方式、压力感受评分差异有统计学意义(P<0.05),消极应对方式、自我效能评分差异无统计学意义(P>0.05);干预后3个月两组间积极应对方式、消极应对方式、压力感受、自我效能评分差异均有统计学意义(P<0.05)。两组维持治疗率差异有统计学意义(P<0.01)。结论:心理干预有利于改善海洛因依赖者的应对方式和自我效能,提高美沙酮维持治疗率。     

Reductions in depressed mood and denial coping during cognitive behavioral stress management with hiv-positive gay men treated with haart

Background: Stress management interventions for HIV-positive persons have been designed to enhance coping skills and encourage health-promoting behaviors with the hope of decreasing distress and slowing disease progression.Purpose: We examined the efficacy of a cognitive behavioral stress management (CBSM) intervention in combination with medication adherence training (MAT) in 130 gay and bisexual men living with HIV infection.Methods: Participants were randomized to either a 10-week CBSM+MAT intervention (n = 76) or a MAT-only condition (n = 54). Measures of self-reported adherence, active cognitive coping (i.e., acceptance and positive reinterpretation), avoidant coping (i.e., denial and behavioral disengagement), and depressed mood were examined over the 10-week intervention period.Results: Men in CBSM+MAT reported reductions in depressed mood and denial coping during the 10-week intervention period, but no changes in active cognitive coping or self-reported adherence were observed. Using path analysis, greater reliance on denial coping at baseline was associated with decreased depressed mood at 10 weeks. We also determined that CBSM+MAT may decrease depressed mood by reducing reliance on denial coping over the 10-week intervention period.Conclusions: Although denial may be an effective means of distress reduction in the short term, reliance on this coping strategy may result in a decreased capacity to effectively manage a variety of disease-related stressors in the long term. CBSM+MAT addresses this potentially detrimental pattern by teaching stress reduction skills that may decrease depressed mood via reduced reliance on denial coping. This research was supported by National Institute of Mental Health Grants P01 MH49548 and T32 MH18917.     

养育方式对青少年心理门诊患者应对方式的影响

目的:了解青少年心理门诊患者的应对方式与父母养育方式的关系. 方法:对107例青少年心理门诊患者(研究组)和104名正常青少年(对照组)进行应对方式和父母养育方式的测评,比较两组之间的差异,并对应对方式和父母养育方式作相关分析. 结果:研究组解决问题、求助的应对方式的评分显著低于对照组,而自责、退避、幻想的方式的评分显著高于对照组;研究组父母养育方式中,父母情感温暖因子评分显著低于对照组,而父母惩罚严厉、拒绝否认因子评分显著高于对照组(P<0.05或P<0.01).相关分析中,积极的应对方式与父母正性的情感因子呈正相关(P<0.05或P<0.01),而消极的应对方式则与父母负性的情感因子呈正相关(P<0.05或P<0.01). 结论:青少年心理门诊患者多采用消极的应对方式,且明显受到父母养育方式的影响.     

Social skills training for hospitalized male arsonists

According to the clinical literature, many arsonists have very poor interpersonal skills. In the present study, social skills training and a control treatment were compared as methods of increasing the social skills of male arsonists in a maximum security psychiatric hospital. Two groups of five patients received eight sessions of both treatments, one group receiving social skills training first, the other receiving the control treatment first. Testing occurred prior to treatment, between treatments, and at the end of both treatments. Behavioral role-playing assessments revealed significant improvements in both groups as a result of social skills training (P < 0.05) but not as a result of the control treatment. Results on a written test, while not significant, were in the same direction. A one year follow-up showed none of the patients has been involved in further firesetting behavior.     

失眠症患者心理社会因素分析

目的:探讨失眠症患者的应付方式,心理健康状况和社会支持状况.方法:采用应付方式问卷(CSQ)、症状自评量表(SCL-90)和社会支持量表(SSS)对失眠症患者和正常对照者各88例进行测评.结果:失眠症组自责、幻想和退避分量表的得分显著高于对照组,求助分量表的得分显著低于对照组(P＜0.01);失眠症组SCL-90总分及躯体化、抑郁、焦虑、睡眠障碍各因子分与对照组比较,有显著差异(P＜0.01).失眠症组社会支持总分、客观支持和对社会支持的利用度评分显著低于正常对照组(P＜0.05).失眠症组自责与躯体化症状、焦虑、抑郁等因子及总分呈显著正相关,而求助与焦虑、抑郁、偏执和总分呈显著负相关(P＜0.05).结论:失眠症患者多采用不成熟的应付方式,且有较多的心身症状,应付方式和身心健康有相关性.失眠症患者缺乏社会支持.     

Patterns of attrition for psychosocial and pharmacologic treatments of depression

Patient characteristics associated with early termination from psychosocial and pharmacologic treatments of depression were delineated. Patients were 125 female primary nonbipolar depressives randomly assigned to 12 weeks of protocol treatment in one of four conditions: social skills training plus placebo; short-term psychotherapy plus placebo; amitriptyline alone; and social skills training plus amitriptyline. Results indicated that premature terminators from pharmacotherapy tended to be mildly depressed and intolerant of medication side effects. In contrast, dropouts from psychosocial treatment were more severely depressed and dissatisfied with the lack of early response which often accompanies interventions of this type. These findings may support the use of short-term psychosocial approaches in lieu of pharmacotherapy in mild nonendogenous depressions. However, antidepressant medication, either alone or in conjunction with psychosocial treatment, should continue to be considered the treatment of choice in more severely depressed melancholic patients.     

工作坊式训练对住院抑郁症患者康复效果的影响

目的探讨工作坊式训练对抑郁症患者自尊水平、应对方式、自我效能及抑郁症状的改善效果。方法选择在某三级精神专科医院住院的82例抑郁症患者为研究对象,均符合《国际疾病分类(第10版)》(ICD-10)抑郁发作诊断标准。采用随机数字表法分为研究组(n=40)和对照组(n=42)。两组患者均接受常规康复训练,研究组在此基础上接受8次工作坊训练。于干预前、干预后第3个月和第6个月采用自尊量表(SES)、简易应对方式问卷(SCSQ)、一般自我效能感量表(GSES)、贝克抑郁量表第2版中文版(BDI-Ⅱ-C)对两组患者进行评定。结果重复测量方差分析显示,干预因素与时间之间存在交互作用(P0. 05)。单独效应分析显示,干预前,研究组和对照组SES、GSES、BDI-II-C、SCSQ各维度评分差异均无统计学意义(P均0. 05);干预3个月后,两组SES、GSES、SCSQ各维度评分差异均有统计学意义(P0. 05或0. 01);干预6个月后,两组SES、GSES、BDI-II-C、SCSQ各维度评分差异均有统计学意义(P0. 05或0. 01)。结论工作坊训练可能有助于提高康复期抑郁症患者的自尊水平和自我效能感,改善应对方式,并有助于预防抑郁症的复发。     

Recurrence of depression after discontinuation of long-term amitriptyline treatment

In this study 10 of 17 patients receiving long-term amitriptyline treatment (average duration: 3.7 years, average dose: 138 mg) had their medication tapered and discontinued under double-blind conditions. Eight became depressed within 3 to 15 weeks. None of the 7 control subjects became depressed during the 6 months of the study. Those who became depressed also showed psychomotor retardation and sleep disturbance. Relief of longstanding anticholinergic side effects followed medication discontinuation. Some patients whose amitryptyline was discontinued experienced a mild withdrawal syndrome within the first 2 weeks, consisting of irritability, dream and sleep disturbance, and restlessness during the first few weeks.